The burden of cholesterol accumulation through the lifespan: why pharmacological intervention should start earlier to go further?

Eur Heart J Cardiovasc Pharmacother. 2021 Sep 21;7(5):435-441. doi: 10.1093/ehjcvp/pvaa123.

Abstract

Among the cardiovascular risk factors, cholesterol-rich atherogenic lipoproteins play a central role in the pathogenesis of atherosclerosis. In middle-aged adults, the size of the total atherosclerotic plaque burden is influenced by both the concentration of circulating atherogenic lipoproteins and the total duration of exposure to these lipoproteins. This review describes the evidence supporting a causal link between lifelong elevations in atherogenic lipoproteins and future risk of atherosclerosis; evidence strengthened by recent epidemiological, genetic, and clinical data. By consequence, adolescence and early adulthood are a crucial time for determining later cardiovascular disease risk. Arguments showing that early optimal lipid control leads to improved outcomes will be presented and suggestions put forward for how those most at risk should be identified and managed.

Keywords: Cardiovascular disease; Cholesterol burden; LDL cholesterol; Lifetime risk; Atherosclerosis.

Publication types

  • Review

MeSH terms

  • Adult
  • Atherosclerosis* / diagnosis
  • Atherosclerosis* / drug therapy
  • Atherosclerosis* / epidemiology
  • Cholesterol
  • Humans
  • Longevity
  • Middle Aged
  • Plaque, Atherosclerotic*

Substances

  • Cholesterol